Loading…
Regulatory evaluation of biosimilars throughout their product life-cycle
The World Health Assembly in 2014 adopted a resolution that recognized the importance of increasing access to biotherapeutic products, of improving their affordability and of ensuring their quality, safety and efficacy. Biosimilars are biotherapeutic products similar to already licensed reference pr...
Saved in:
Published in: | Bulletin of the World Health Organization 2018-04, Vol.96 (4), p.281-285 |
---|---|
Main Authors: | , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503 |
---|---|
cites | cdi_FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503 |
container_end_page | 285 |
container_issue | 4 |
container_start_page | 281 |
container_title | Bulletin of the World Health Organization |
container_volume | 96 |
creator | Kang, Hye-Na Knezevic, Ivana |
description | The World Health Assembly in 2014 adopted a resolution that recognized the importance of increasing access to biotherapeutic products, of improving their affordability and of ensuring their quality, safety and efficacy. Biosimilars are biotherapeutic products similar to already licensed reference products and are usually developed after patents on the original products have expired. Their introduction into the market is likely to reduce the costs of medicines substantially, thereby improving the availability of treatment for patients. However, there are barriers to market access for biosimilars. This article discusses the factors that give rise to these barriers and explains the importance of regulatory oversight throughout the product life-cycle of biosimilars. The paper also describes the role regulators can play in increasing confidence in biosimilars use by: (i) establishing regulatory oversight of biosimilars throughout their life-cycle, from development to post-licensing oversight, and ensuring that only high-quality, safe and efficacious biosimilars are available on the market; (ii) ensuring regulatory authorities have adequate capacity to assess and monitor the quality, safety and efficacy of biosimilars throughout their life-cycle; and (iii) monitoring the use of biosimilars in public health systems in collaboration with other stakeholders. |
doi_str_mv | 10.2471/BLT.17.206284 |
format | article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5872015</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2051199865</sourcerecordid><originalsourceid>FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503</originalsourceid><addsrcrecordid>eNpdkUtLAzEUhYMoWh9LtzLgxs3UvCaTbAQVX1AQpK5DJpNpI-mkJpNC_70p1aLezb1wPg73cAA4R3CMaY2u7ybTMarHGDLM6R4YoYrREjJI98EIQopLwTg7AscxfsA8gsJDcIQFExXndASe38wsOTX4sC7MSrmkBuv7wndFY320C-tUiMUwDz7N5j4N-TQ2FMvg26SHwtnOlHqtnTkFB51y0Zx97xPw_vgwvX8uJ69PL_e3k1KTmg1lZQTkgrJWKd0qTVGHiIAdy1mwagmvIGlaXauG1bqFjcG064gglCKhOcnqCbjZ-i5TszCtNv0QlJPLYBcqrKVXVv5VejuXM7-SFa8xRFU2uPo2CP4zmTjIhY3aOKd641OUGBJEEaNwg17-Qz98Cn2Ol6kKISE421DlltLBxxhMt3sGQbnpSOaOJKrltqPMX_xOsKN_SiFfpeeNoQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2051199865</pqid></control><display><type>article</type><title>Regulatory evaluation of biosimilars throughout their product life-cycle</title><source>International Bibliography of the Social Sciences (IBSS)</source><source>ABI/INFORM Global (ProQuest)</source><source>Social Science Premium Collection</source><source>Politics Collection</source><source>PAIS Index</source><source>PubMed Central</source><creator>Kang, Hye-Na ; Knezevic, Ivana</creator><creatorcontrib>Kang, Hye-Na ; Knezevic, Ivana</creatorcontrib><description>The World Health Assembly in 2014 adopted a resolution that recognized the importance of increasing access to biotherapeutic products, of improving their affordability and of ensuring their quality, safety and efficacy. Biosimilars are biotherapeutic products similar to already licensed reference products and are usually developed after patents on the original products have expired. Their introduction into the market is likely to reduce the costs of medicines substantially, thereby improving the availability of treatment for patients. However, there are barriers to market access for biosimilars. This article discusses the factors that give rise to these barriers and explains the importance of regulatory oversight throughout the product life-cycle of biosimilars. The paper also describes the role regulators can play in increasing confidence in biosimilars use by: (i) establishing regulatory oversight of biosimilars throughout their life-cycle, from development to post-licensing oversight, and ensuring that only high-quality, safe and efficacious biosimilars are available on the market; (ii) ensuring regulatory authorities have adequate capacity to assess and monitor the quality, safety and efficacy of biosimilars throughout their life-cycle; and (iii) monitoring the use of biosimilars in public health systems in collaboration with other stakeholders.</description><identifier>ISSN: 0042-9686</identifier><identifier>EISSN: 1564-0604</identifier><identifier>DOI: 10.2471/BLT.17.206284</identifier><identifier>PMID: 29695884</identifier><language>eng</language><publisher>Switzerland: World Health Organization</publisher><subject>Access ; Affordability ; Biological products ; Biological Products - therapeutic use ; Biosimilar Pharmaceuticals - therapeutic use ; Chronic illnesses ; Collaboration ; Constraints ; Drug and Narcotic Control ; Drugs ; Effectiveness ; Efficacy ; Health care ; Health Services Accessibility ; Humans ; Interest groups ; Licensure ; Life cycles ; Manufacturing ; Markets ; Medical treatment ; Oversight ; Patients ; Pharmacovigilance ; Policy & Practice ; Process controls ; Product safety ; Public health ; Quality ; Quality assessment ; Quality standards ; Regulatory agencies ; Safety ; Standardization ; Trust</subject><ispartof>Bulletin of the World Health Organization, 2018-04, Vol.96 (4), p.281-285</ispartof><rights>Copyright World Health Organization Apr 2018</rights><rights>(c) 2018 The authors; licensee World Health Organization. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503</citedby><cites>FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2051199865/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2051199865?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,11686,12845,21385,21392,27864,27922,27923,33221,33609,33610,33983,33984,36058,36059,43731,43946,44361,53789,53791,73991,74238,74665</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29695884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Hye-Na</creatorcontrib><creatorcontrib>Knezevic, Ivana</creatorcontrib><title>Regulatory evaluation of biosimilars throughout their product life-cycle</title><title>Bulletin of the World Health Organization</title><addtitle>Bull World Health Organ</addtitle><description>The World Health Assembly in 2014 adopted a resolution that recognized the importance of increasing access to biotherapeutic products, of improving their affordability and of ensuring their quality, safety and efficacy. Biosimilars are biotherapeutic products similar to already licensed reference products and are usually developed after patents on the original products have expired. Their introduction into the market is likely to reduce the costs of medicines substantially, thereby improving the availability of treatment for patients. However, there are barriers to market access for biosimilars. This article discusses the factors that give rise to these barriers and explains the importance of regulatory oversight throughout the product life-cycle of biosimilars. The paper also describes the role regulators can play in increasing confidence in biosimilars use by: (i) establishing regulatory oversight of biosimilars throughout their life-cycle, from development to post-licensing oversight, and ensuring that only high-quality, safe and efficacious biosimilars are available on the market; (ii) ensuring regulatory authorities have adequate capacity to assess and monitor the quality, safety and efficacy of biosimilars throughout their life-cycle; and (iii) monitoring the use of biosimilars in public health systems in collaboration with other stakeholders.</description><subject>Access</subject><subject>Affordability</subject><subject>Biological products</subject><subject>Biological Products - therapeutic use</subject><subject>Biosimilar Pharmaceuticals - therapeutic use</subject><subject>Chronic illnesses</subject><subject>Collaboration</subject><subject>Constraints</subject><subject>Drug and Narcotic Control</subject><subject>Drugs</subject><subject>Effectiveness</subject><subject>Efficacy</subject><subject>Health care</subject><subject>Health Services Accessibility</subject><subject>Humans</subject><subject>Interest groups</subject><subject>Licensure</subject><subject>Life cycles</subject><subject>Manufacturing</subject><subject>Markets</subject><subject>Medical treatment</subject><subject>Oversight</subject><subject>Patients</subject><subject>Pharmacovigilance</subject><subject>Policy & Practice</subject><subject>Process controls</subject><subject>Product safety</subject><subject>Public health</subject><subject>Quality</subject><subject>Quality assessment</subject><subject>Quality standards</subject><subject>Regulatory agencies</subject><subject>Safety</subject><subject>Standardization</subject><subject>Trust</subject><issn>0042-9686</issn><issn>1564-0604</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>7TQ</sourceid><sourceid>8BJ</sourceid><sourceid>ALSLI</sourceid><sourceid>DPSOV</sourceid><sourceid>M0C</sourceid><sourceid>M2L</sourceid><sourceid>M2R</sourceid><recordid>eNpdkUtLAzEUhYMoWh9LtzLgxs3UvCaTbAQVX1AQpK5DJpNpI-mkJpNC_70p1aLezb1wPg73cAA4R3CMaY2u7ybTMarHGDLM6R4YoYrREjJI98EIQopLwTg7AscxfsA8gsJDcIQFExXndASe38wsOTX4sC7MSrmkBuv7wndFY320C-tUiMUwDz7N5j4N-TQ2FMvg26SHwtnOlHqtnTkFB51y0Zx97xPw_vgwvX8uJ69PL_e3k1KTmg1lZQTkgrJWKd0qTVGHiIAdy1mwagmvIGlaXauG1bqFjcG064gglCKhOcnqCbjZ-i5TszCtNv0QlJPLYBcqrKVXVv5VejuXM7-SFa8xRFU2uPo2CP4zmTjIhY3aOKd641OUGBJEEaNwg17-Qz98Cn2Ol6kKISE421DlltLBxxhMt3sGQbnpSOaOJKrltqPMX_xOsKN_SiFfpeeNoQ</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Kang, Hye-Na</creator><creator>Knezevic, Ivana</creator><general>World Health Organization</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7RV</scope><scope>7T2</scope><scope>7TQ</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88C</scope><scope>88E</scope><scope>88J</scope><scope>8AF</scope><scope>8AO</scope><scope>8BJ</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>8G5</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DPSOV</scope><scope>DWQXO</scope><scope>FQK</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>JBE</scope><scope>K60</scope><scope>K6~</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KC-</scope><scope>L.-</scope><scope>L6V</scope><scope>M0C</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2L</scope><scope>M2O</scope><scope>M2R</scope><scope>M7S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PATMY</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180401</creationdate><title>Regulatory evaluation of biosimilars throughout their product life-cycle</title><author>Kang, Hye-Na ; Knezevic, Ivana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Access</topic><topic>Affordability</topic><topic>Biological products</topic><topic>Biological Products - therapeutic use</topic><topic>Biosimilar Pharmaceuticals - therapeutic use</topic><topic>Chronic illnesses</topic><topic>Collaboration</topic><topic>Constraints</topic><topic>Drug and Narcotic Control</topic><topic>Drugs</topic><topic>Effectiveness</topic><topic>Efficacy</topic><topic>Health care</topic><topic>Health Services Accessibility</topic><topic>Humans</topic><topic>Interest groups</topic><topic>Licensure</topic><topic>Life cycles</topic><topic>Manufacturing</topic><topic>Markets</topic><topic>Medical treatment</topic><topic>Oversight</topic><topic>Patients</topic><topic>Pharmacovigilance</topic><topic>Policy & Practice</topic><topic>Process controls</topic><topic>Product safety</topic><topic>Public health</topic><topic>Quality</topic><topic>Quality assessment</topic><topic>Quality standards</topic><topic>Regulatory agencies</topic><topic>Safety</topic><topic>Standardization</topic><topic>Trust</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Hye-Na</creatorcontrib><creatorcontrib>Knezevic, Ivana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Source (ProQuest)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>ABI商业信息数据库</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>ProQuest Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Business Premium Collection</collection><collection>Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>Politics Collection</collection><collection>ProQuest Central Korea</collection><collection>International Bibliography of the Social Sciences</collection><collection>Business Premium Collection (Alumni)</collection><collection>Health Research Premium Collection</collection><collection>ABI/INFORM Global (Corporate)</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Politics Collection</collection><collection>ABI/INFORM Professional Advanced</collection><collection>ProQuest Engineering Collection</collection><collection>ABI/INFORM Global (ProQuest)</collection><collection>ProQuest Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Political Science Database</collection><collection>ProQuest research library</collection><collection>Social Science Database (ProQuest)</collection><collection>Engineering Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Environmental Science Database</collection><collection>One Business (ProQuest)</collection><collection>ProQuest One Business (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Bulletin of the World Health Organization</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Hye-Na</au><au>Knezevic, Ivana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regulatory evaluation of biosimilars throughout their product life-cycle</atitle><jtitle>Bulletin of the World Health Organization</jtitle><addtitle>Bull World Health Organ</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>96</volume><issue>4</issue><spage>281</spage><epage>285</epage><pages>281-285</pages><issn>0042-9686</issn><eissn>1564-0604</eissn><abstract>The World Health Assembly in 2014 adopted a resolution that recognized the importance of increasing access to biotherapeutic products, of improving their affordability and of ensuring their quality, safety and efficacy. Biosimilars are biotherapeutic products similar to already licensed reference products and are usually developed after patents on the original products have expired. Their introduction into the market is likely to reduce the costs of medicines substantially, thereby improving the availability of treatment for patients. However, there are barriers to market access for biosimilars. This article discusses the factors that give rise to these barriers and explains the importance of regulatory oversight throughout the product life-cycle of biosimilars. The paper also describes the role regulators can play in increasing confidence in biosimilars use by: (i) establishing regulatory oversight of biosimilars throughout their life-cycle, from development to post-licensing oversight, and ensuring that only high-quality, safe and efficacious biosimilars are available on the market; (ii) ensuring regulatory authorities have adequate capacity to assess and monitor the quality, safety and efficacy of biosimilars throughout their life-cycle; and (iii) monitoring the use of biosimilars in public health systems in collaboration with other stakeholders.</abstract><cop>Switzerland</cop><pub>World Health Organization</pub><pmid>29695884</pmid><doi>10.2471/BLT.17.206284</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0042-9686 |
ispartof | Bulletin of the World Health Organization, 2018-04, Vol.96 (4), p.281-285 |
issn | 0042-9686 1564-0604 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5872015 |
source | International Bibliography of the Social Sciences (IBSS); ABI/INFORM Global (ProQuest); Social Science Premium Collection; Politics Collection; PAIS Index; PubMed Central |
subjects | Access Affordability Biological products Biological Products - therapeutic use Biosimilar Pharmaceuticals - therapeutic use Chronic illnesses Collaboration Constraints Drug and Narcotic Control Drugs Effectiveness Efficacy Health care Health Services Accessibility Humans Interest groups Licensure Life cycles Manufacturing Markets Medical treatment Oversight Patients Pharmacovigilance Policy & Practice Process controls Product safety Public health Quality Quality assessment Quality standards Regulatory agencies Safety Standardization Trust |
title | Regulatory evaluation of biosimilars throughout their product life-cycle |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T02%3A32%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Regulatory%20evaluation%20of%20biosimilars%20throughout%20their%20product%20life-cycle&rft.jtitle=Bulletin%20of%20the%20World%20Health%20Organization&rft.au=Kang,%20Hye-Na&rft.date=2018-04-01&rft.volume=96&rft.issue=4&rft.spage=281&rft.epage=285&rft.pages=281-285&rft.issn=0042-9686&rft.eissn=1564-0604&rft_id=info:doi/10.2471/BLT.17.206284&rft_dat=%3Cproquest_pubme%3E2051199865%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c376t-5e908946daacdac41f1390f62472ad38503bdc7ab67cd0be24ff3934419c83503%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2051199865&rft_id=info:pmid/29695884&rfr_iscdi=true |